[HSF] Ao Wraping

[Hgrmd at aol.com]

Ed,
  Why do you think the number of Ross's done per year has been  decreasing 
over the last few years?  How many of your 100 cases have  required reoperation 
or any type of intervention (this includes RVOT  obstruction)?  I've heard the 
pros and cons for years, but can't get past  the fact that you've now created 
double valve out of single valve disease.   Part of my bias is influenced by 
being asked to review the fatal outcome of a  Ross done in a 24 yo single 
mother of 3.  She died of an anteroseptal MI,  presumably due to the scariest Ross 
complication of harvesting the  autograft.  I'm sure, with experience, this 
awful complication is totally  avoidable.  However, it illustrates the great 
potential pitfalls with this  procedure.  
  In contrast, a Magna valve has excellent hemodynamics and an  expected 
longevity of 15 years. In addition, it is a usually easy to  install.  A redo is 
difficult, but certainly not impossible.  How long  do you think the average 
Ross will last without need for any intervention?   Patients that are usually 
candidates for a Ross are patients with an expected  mortality about 1% more 
than an ASD, i.e., 1%.  To me, it's tough to  rationalize exposing them to that 
much additional potential risk.  I'm  impressed with what you are doing and 
would certainly refer a hell-bent Ross  candidate your way.  However, with what 
I've seen and read thus far, I  honestly don't think I'd have one done to me or 
my family.
Hal



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